Gastric Ulcers Developing during Gastric Acid Suppressive Therapy: Report of Three Cases
2020 Volume 4 Issue 1 Pages 37-42
Details
2020 Volume 4 Issue 1 Pages 37-42
Both Helicobacter pylori (H. pylori) eradication and gastric acid secretion inhibitors such as proton pump inhibitors are effective therapy to prevent the recurrence of peptic ulcers. We reported three cases of gastric ulcers which developed during gastric acid suppressive therapy.
Case 1 was an 88-year-old man treated with proton pump inhibitor (lansoprazole 15 mg) therapy and low-dose aspirin (LDA: 100 mg/day) after a myocardial infarction. The patient visited our clinic and underwent upper gastrointestinal endoscopy for epigastric pain and melena. Multiple hemorrhagic ulcers were observed in the gastric antrum. He was H.pylori-negative and was treated by the potassium-competitive acid blocker (vonoprazan fumarate 20 mg/day) and misoprostol. Case 2 was an 84-year-old woman who received LDA (100 mg/day) as well as anticoagulant therapy (dabigatran etexilate) after an atrial fibrillation-related cerebral infarction, vonoprazan fumarate (10 mg/day) for gastro-esophageal reflux disease (GERD), and cyclooxygenase (COX) -2-selective inhibitor (celecoxib) therapy for lumbar pain. Upper gastrointestinal endoscopy showed an ulcer on the posterior wall of the upper gastric body and marked atrophic mucosa of the corpus. The patient had the eradication therapy for H.pylori two years ago and was confirmed as H.pylori-negative following the eradication treatment. Celecoxib was discontinued, and she was treated with vonoprazan fumarate (20 mg/day) and misoprostol. Case 3 was a 76-year-old woman. During H2-receptor antagonist (nizatidine 300 mg/day) therapy for GERD, an ulcer was detected in the pyloric antrum by upper gastrointestinal endoscopy during follow-up. She had the eradication therapy five years ago and was confirmed as H.pylori-negative following eradication treatment. She had also received therapy for hypertension and hyperlipidemia but no COX-inhibitors. Her ulcer was further treated with vonoprazan fumarate (20 mg/day). It was a case that long-term stress might have been involved in the development.
As in the case reported here, the practicing doctor should recognize that gastric ulcer caused by the drugs occurs even if H.pylori is negative and takes the gastric acid secretion inhibitor, and considers appropriate measures for each case.
